Dallas Ear Institute
7777 Forest Lane, Suite A-103, Dallas, TX 75230 | Phone: (972) 566-7600 | Fax: (972) 566-6560 | www.dallasear.com

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Attic Cholesteatoma Case Number 1

1) The tympanic membrane (eardrum) is visualized through the ear canal.  The defect in the ear drum is seen and indicated with the black arrow.  This is a cholesteatoma that has formed.  The area of the superior portion of the eardrum is retracted, or sucked in, trapping skin cells and debris and eating away at the hearing bones and ear canal bone.  The blue arrow shows the cholesteatoma pocket within the middle ear.

2) The eardrum has been lifted by making an incision in the ear canal.  There is significant inflammation in the middle ear as well as cholesteatoma sitting on top of, and eroding into, the hearing bones (black arrow).
3) The blue arrow is showing the cholesteatoma within the middle ear cavity.  This skin accumulates and damages the structures of the middle ear and inner ear.  The black arrow is pointing to an eroded section of the incus, the 2nd hearing bone, that has been eaten away by the cholesteatoma.
4) This image shows the remnant of the 2nd hearing bone, the incus, commonly known as the anvil, that has been eaten away.  This causes a significant hearing loss.
5) A view through the mastoid cavity, which is behind and above the ear canal, is seen.  The red arrow signifies the ear canal bone, which is intact.  The black arrow represents the head of the incus, the 2nd hearing bone.  The blue arrow is pointing towards significant skin elements within the upper part of the middle ear and opening into the mastoid.  This trapped skin signifies the cholesteatoma.
6) The malleus, or 1st hearing bone is clearly seen now that the eardrum has been lifted off of it.  The blue arrow is showing the stapes bone, the 3rd hearing bone, that conducts sound into the inner ear.  The black arrow is showing the undersurface of the remnant eardrum.

7) The reconstruction of the defect that the cholesteatoma caused is prepared.  A cartilage and perichondrail graft is utilized to rebuild the ear canal bone that has been eaten away by the cholesteatoma.  This will repair this defect and prevent future retraction.

8) The remnant eardrum is indicated by the black arrow.  The defect in the eardrum and ear canal wall is shown with the blue arrow.  Reconstruction of this defect is required.
9) Because the 2nd hearing bone was eroded by the cholesteatoma, the hearing bones must be reconstructed to rebuild the hearing mechanism.  Thus, in this case, a hydroxyapatite prosthesis is used to bridge the gap between the 1st hearing bone and the 3rd hearing bone.   This tubular structure sits atop the stapes, the 3rd hearing bone, and connects this bone to the malleus, the 1st hearing bone.  Thus, when sound hits the eardrum, it will vibrate the fluid of the inner ear through this mechanism.  In addition, the cartilage graft is seen (blue arrow) from the undersurface and will repair the ear canal defect.
10) The final repair from the ear canal is now visualized.  The cartilage repair is seen and is in excellent position for expected healing.

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Dallas Ear Institute
7777 Forest Lane, Suite A-103, Dallas, TX 75230 | Phone: (972) 566-7600 | Fax: (972) 566-6560 | www.dallasear.com